Physician report form 2026

1. Click ‘Get Form’ to open the physician report form in the editor.
2. Begin by filling out your name, program, and signature at the top of the form. Ensure that this information is accurate as it is essential for processing.
3. Select the term(s) applicable to you by checking the appropriate boxes for Summer, Fall, Spring, or January/May.
4. Provide this form to your physician for completion. They will need to fill out their observations based on a recent examination within four months of your program departure date.
5. Your physician should answer all questions regarding your health status, including vital signs and any medical history that may affect your participation in the program.
6. If there are any conditions that could impact your ability to participate fully, ensure these are detailed on a separate sheet signed by your physician.
7. Once completed, review the form for accuracy before submitting it back to CIEE International Study Programs staff.

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